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Will the New DSM Label Grief as Depression?

Individuals suffering from major depression often experience a loss of appetite, irregular sleep, fatigue and a loss of interest in activities. So do people who have recently experienced the death of a loved one. So where do mental health professionals distinguish between the normal effects of grief and grief that has triggered severe depression?

NPR's Alix Spiegal reports this week that a small change in the forthcoming Diagnostic and Statistical Manual of Mental Disorders (DSM) will have a significant impact on where this line is drawn and how these symptoms are treated.

In the new DSM-V (the diagnostic “bible” for mental health professionals), the bereavement exception will be removed from the diagnosis of depression so that grief that lasts more than two weeks will now be classified as depression and treated as such. Spiegel argues that grieving is a normal part of losing someone and that losing someone as important to your life as a child or a spouse will lead to grief lasting more then two weeks. She is concerned that people suffering from bereavement will be medicated for depression and unable to properly process their losses.

However, this article misses a very important issue. A diagnosis of depression does not (or at least, in my opinion, should not) immediately lead to medication. Rather, a diagnosis of depression should open doors for individuals to receive mental health counseling, and perhaps, if necessary medication. This article does not address the issue of counseling at all. It assumes that a diagnosis of depression will automatically lead to medication.

As a therapist, I would hope that a psychiatrist would examine the patient’s history, and even given the diagnosis of depression, realize that his or her depression is linked to a particular event (in the case of the article, a death). That person should then be referred to counseling services to process his or her loss, not just given a “magic pill” to make it all better. Of course, if removing the bereavement exception from the depression diagnosis allows more individuals to receive counseling services during their time of grief then it will be a positive change to the DSM.